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General NPI Number Information
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NPI Number | 1134237639
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Entity Type | Organization
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Legal Business Name | PODIATRIC MEDICAL ASSOCIATES PC
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Dates
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Enumeration Date | 08/26/2006
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Last Update Date | 12/05/2013
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Provider Practice Location Address
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Address Line | 303 W 89TH AVE SUITE E-1
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City | MERRILLVILLE
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State | IN
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Zip | 46410
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Country | US
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Telephone | 219-736-8915
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Fax | 219-736-8928
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Provider Business Mailing Address
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Address Line | 303 W 89TH AVE SUITE E-1
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City | MERRILLVILLE
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State | IN
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Zip | 46410
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Country | US
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Telephone | 219-736-8915
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Fax | 219-736-8928
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN K GRANDFIELD
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Credential | DPM
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Telephone | 219-736-8915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 07000353A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 07000785A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 07000922A
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License Number State | IN
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